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1.
Int J Environ Res Public Health ; 19(21)2022 Nov 07.
Article in English | MEDLINE | ID: covidwho-2143068

ABSTRACT

Throughout history a variety of therapeutic tools have been studied as possible enhancers of sports activities. This study proposes the use of Capacitive-Resistive Electric Transfer (CRET) as a performance booster to paralympic athletes, specifically those belonging to the Spanish Paralympic swimming committee. The study was a randomized, single-blind, and observer-blind, crossover clinical trial. Six athletes were randomly assigned to three groups: one treated with CRET (A); a placebo group (B) and a control group (C). The CRET group attended a twenty-minute session before being subjected to pool trials at distances of 50 and 100 m at maximum performance. Measurements were in two dimensions: time in seconds and the Borg scale for perceived exertion. Comparisons between groups were made with respect to distance and the main variables. In the case of perceived exertion, no significant changes were observed in any of the distances; however, in the case of the time variable, a significant difference was observed between Group A vs. Personal Record at 100 m distance (76.3 ± 6.8 vs. 68.4 ± 3.3). The proposed protocol and level of hyperthermia applied suggest refusal of CRET use for the 100-m distance a few minutes before sports practice. Our analysis suggests the need to modify the presented protocol. ClinicalTrials.gov identifier under NCT number: NCT04336007.


Subject(s)
Athletic Performance , Hyperthermia, Induced , Humans , Single-Blind Method , Swimming , Athletes
2.
J Surg Oncol ; 126(8): 1375-1382, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2013659

ABSTRACT

BACKGROUND AND OBJECTIVES: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex treatment used in selected patients with peritoneal surface malignancies. HIPEC procedures are time and resource intensive. The primary aim of this analysis was to compare the experience of treating advanced abdominal tumors with CRS-HIPEC before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Patients included in this analysis received CRS-HIPEC at a single center during either a prepandemic (March 18, 2019-March 17, 2020) or pandemic (March 18, 2020-February 5, 2021) interval. A retrospective chart review was performed. RESULTS: Our analysis included 67 patients: 30 (45%) treated prepandemic and 37 (55%) treated during the pandemic. Median age at the time of operation was 58 years (interquartile range: [49-65]); 53% of patients were women. Patients treated during the pandemic presented with higher peritoneal cancer index (PCI) scores with 32% (n = 12) having a PCI > 20 at the time of surgery (p = 0.01). Five patients had delays in surgery due to the pandemic. Rates of overall postoperative morbidity, reoperation, and readmission were not different between the cohorts. CONCLUSIONS: Despite presenting with more extensive disease, patients treated with CRS-HIPEC during the height of the COVID-19 pandemic had comparable perioperative outcomes to patients treated prepandemic.


Subject(s)
COVID-19 , Hyperthermia, Induced , Peritoneal Neoplasms , Humans , Female , Middle Aged , Male , Cytoreduction Surgical Procedures/adverse effects , Peritoneal Neoplasms/pathology , COVID-19/epidemiology , Hyperthermic Intraperitoneal Chemotherapy , Chemotherapy, Cancer, Regional Perfusion/methods , Pandemics , Retrospective Studies , Feasibility Studies , Hyperthermia, Induced/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Survival Rate , Combined Modality Therapy
4.
BMJ Open ; 12(8): e051324, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-1973838

ABSTRACT

INTRODUCTION: Up to one-fifth of patients with colorectal cancer will develop peritoneal metastases, frequently without other districts' involvement. Despite the recent unsuccesses of hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal cancer peritoneal metastases treatment, the rationale in the prophylactic setting remains strong. Several clinical and pharmacokinetic data suggest that the efficacy of intraperitoneal chemotherapy is highest when the disease is microscopic. However, robust evidence demonstrating whether the addition of HIPEC for high-risk colorectal cancers offers better control of local recurrence is lacking. METHODS AND ANALYSIS: This is a multicentre randomised phase 3 trial comparing prophylactic surgery plus HIPEC CO2 with mitomycin, over standard surgical excision in patients with colorectal cancer at high risk of peritoneal carcinomatosis; 388 patients will be included in this study. The primary objective is to compare the efficacy of prophylactic surgery (radical colorectal resection, omentectomy, appendectomy, round ligament of the liver resection and bilateral adnexectomy) plus HIPEC CO2 with mitomycin and standard surgery in terms of local recurrence-free survival. The main secondary endpoints are disease-free survival (DFS), overall survival (OS) and safety. The primary endpoint will be described with a cumulative incidence function and will be analysed with Grey test to take account of the competing risks. DFS and OS will be described with the Kaplan-Meier method. ETHICS AND DISSEMINATION: This trial has been evaluated by the Italian Medicines Agency, local ethics committees and will be submitted to the Ministry of Health to notify the start of the trial according to the regulation of trials on devices with CE mark/certification.The results will be submitted for presentation at academic meetings and for publication in a peer-reviewed journal, whatever the findings. TRIAL REGISTRATION NUMBER: NCT03914820.


Subject(s)
Colorectal Neoplasms , Hyperthermia, Induced , Peritoneal Neoplasms , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carbon Dioxide , Clinical Trials, Phase III as Topic , Colorectal Neoplasms/drug therapy , Combined Modality Therapy , Cytoreduction Surgical Procedures/methods , Female , Humans , Hyperthermia, Induced/methods , Hyperthermic Intraperitoneal Chemotherapy , Mitomycins/therapeutic use , Multicenter Studies as Topic , Peritoneal Neoplasms/secondary , Randomized Controlled Trials as Topic
6.
J Thromb Haemost ; 20(10): 2284-2292, 2022 10.
Article in English | MEDLINE | ID: covidwho-1949716

ABSTRACT

BACKGROUND: Erythrocyte aggregation is a phenomenon that is commonly found in several pathological disease states: stroke, myocardial infarction, thermal burn injury, and COVID-19. Erythrocyte aggregation is characterized by rouleaux, closely packed stacks of cells, forming three-dimensional structures. Healthy blood flow monodisperses the red blood cells (RBCs) throughout the vasculature; however, in select pathological conditions, involving hyperthermia and hypoxemia, rouleaux formation remains and results in occlusion of microvessels with decreased perfusion. OBJECTIVES: Our objective is to address the kinetics of rouleaux formation with sudden cessation of flow in variable temperature and oxygen conditions. METHODS: RBCs used in this in vitro system were obtained from healthy human donors. Using a vertical stop-flow system aligned with a microscope, images were acquired and analyzed for increased variation in grayscale to indicate increased aggregation. The onset of aggregation after sudden cessation of flow was determined at proscribed temperatures (37-49°C) and oxygen (0%, 10%), and in the presence and absence of 4, 4'-Diisothiocyano-2,2'-stilbenedisulfonic acid (DIDS). Both autologous and homologous plasma were tested. RESULTS: RBCs in autologous plasma aggregate faster and with a higher magnitude with both hyperthermia and hypoxemia. Preventing deoxyhemoglobin from binding to band 3 with DIDS (dissociates the cytoskeleton from the membrane) fully blocks aggregation. Further, RBC aggregation magnitude is greater in autologous plasma. CONCLUSIONS: We show that the C-terminal domain of band 3 plays a pivotal role in RBC aggregation. Further, aggregation is enhanced by hyperthermia and hypoxemia.


Subject(s)
COVID-19 , Hyperthermia, Induced , 4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid/metabolism , Erythrocyte Aggregation/physiology , Erythrocytes/metabolism , Humans , Hypoxia , Oxygen/metabolism
7.
Crit Care Med ; 50(6): 924-934, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1874016

ABSTRACT

OBJECTIVES: To test the hypothesis that forced-air warming of critically ill afebrile sepsis patients improves immune function compared to standard temperature management. DESIGN: Single-center, prospective, open-label, randomized controlled trial. SETTING: One thousand two hundred-bed academic medical center. PATIENTS: Eligible patients were mechanically ventilated septic adults with: 1) a diagnosis of sepsis within 48 hours of enrollment; 2) anticipated need for mechanical ventilation of greater than 48 hours; and 3) a maximum temperature less than 38.3°C within the 24 hours prior to enrollment. Primary exclusion criteria included: immunologic diseases, immune-suppressing medications, and any existing condition sensitive to therapeutic hyperthermia (e.g., brain injury). The primary outcome was monocyte human leukocyte antigen (HLA)-DR expression, with secondary outcomes of CD3/CD28-induced interferon gamma (IFN-γ) production, mortality, and 28-day hospital-free days. INTERVENTIONS: External warming using a forced-air warming blanket for 48 hours, with a goal temperature 1.5°C above the lowest temperature documented in the previous 24 hours. MEASUREMENTS AND MAIN RESULTS: We enrolled 56 participants in the study. No differences were observed between the groups in HLA-DR expression (692 vs 2,002; p = 0.396) or IFN-γ production (31 vs 69; p = 0.678). Participants allocated to external warming had lower 28-day mortality (18% vs 43%; absolute risk reduction, 25%; 95% CI, 2-48%) and more 28-day hospital-free days (difference, 2.6 d; 95% CI, 0-11.6). CONCLUSIONS: Participants randomized to external forced-air warming did not have a difference in HLA-DR expression or IFN-γ production. In this pilot study, however, 28-day mortality was lower in the intervention group. Future research should seek to better elucidate the impact of temperature modulation on immune and nonimmune organ failure pathways in sepsis.


Subject(s)
COVID-19 , Hyperthermia, Induced , Sepsis , Adult , Critical Illness/therapy , HLA-DR Antigens , Humans , Pilot Projects , Prospective Studies , SARS-CoV-2 , Sepsis/therapy
8.
Cancer Med ; 10(23): 8432-8450, 2021 12.
Article in English | MEDLINE | ID: covidwho-1469423

ABSTRACT

BACKGROUND AND AIMS: The existing evidence has indicated that hyperthermia ablation (HA) and HA combined with transarterial chemoembolization (HATACE) are the optimal alternative to surgical resection for patients with hepatocellular carcinoma (HCC) in the COVID-19 crisis. However, the evidence for decision-making is lacking in terms of comparison between HA and HATACE. Herein, a comprehensive evaluation was performed to compare the efficacy and safety of HATACE with monotherapy. MATERIALS AND METHODS: Worldwide studies were collected to evaluate the HATACE regimen for HCC due to the practical need for global extrapolation of applicative population. Meta-analyses were performed using the RevMan 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). RESULTS: Thirty-six studies involving a large sample of 5036 patients were included finally. Compared with HA alone, HATACE produced the advantage of 5-year overall survival (OS) rate (OR:1.90; 95%CI:1.46,2.46; p < 0.05) without increasing toxicity (p ≥ 0.05). Compared with TACE alone, HATACE was associated with superior 5-year OS rate (OR:3.54; 95%CI:1.96,6.37; p < 0.05) and significantly reduced the incidences of severe liver damage (OR:0.32; 95%CI:0.11,0.96; p < 0.05) and ascites (OR:0.42; 95%CI:0.20,0.88; p < 0.05). Subgroup analysis results of small (≤3 cm) HCC revealed that there were no significant differences between the HATACE group and HA monotherapy group in regard to the OS rates (p ≥ 0.05). CONCLUSIONS: Compared with TACE alone, HATACE was more effective and safe for HCC. Compared with HA alone, HATACE was more effective for non-small-sized (>3 cm) HCC with comparable safety. However, the survival benefit of adjuvant TACE in HATACE regimen was not found for the patients with small (≤3 cm) HCC.


Subject(s)
Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic/methods , Hyperthermia, Induced/methods , Liver Neoplasms/therapy , COVID-19 , Carcinoma, Hepatocellular/mortality , Combined Modality Therapy , Humans , Liver Neoplasms/mortality , Randomized Controlled Trials as Topic , Treatment Outcome
9.
J Neuroimmunol ; 358: 577654, 2021 09 15.
Article in English | MEDLINE | ID: covidwho-1386080

ABSTRACT

Increasing evidence suggests that SARS-CoV-2, the virus responsible for the COVID-19 pandemic, is associated with increased risk of developing neurological or psychiatric conditions such as depression, anxiety or dementia. While the precise mechanism underlying this association is unknown, aberrant activation of toll-like receptor (TLR)3, a viral recognizing pattern recognition receptor, may play a key role. Synthetic cannabinoids and enhancing cannabinoid tone via inhibition of fatty acid amide hydrolase (FAAH) has been demonstrated to modulate TLR3-induced neuroimmune responses and associated sickness behaviour. However, the role of individual FAAH substrates, and the receptor mechanisms mediating these effects, are unknown. The present study examined the effects of intracerebral or systemic administration of the FAAH substrates N-oleoylethanolamide (OEA), N-palmitoylethanolamide (PEA) or the anandamide (AEA) analogue meth-AEA on hyperthermia and hypothalamic inflammatory gene expression following administration of the TLR3 agonist, and viral mimetic, poly I:C. The data demonstrate that meth-AEA does not alter TLR3-induced hyperthermia or hypothalamic inflammatory gene expression. In comparison, OEA and PEA attenuated the TLR3-induced hyperthermia, although only OEA attenuated the expression of hyperthermia-related genes (IL-1ß, iNOS, COX2 and m-PGES) in the hypothalamus. OEA, but not PEA, attenuated TLR3-induced increases in the expression of all IRF- and NFκB-related genes examined in the hypothalamus, but not in the spleen. Antagonism of PPARα prevented the OEA-induced attenuation of IRF- and NFκB-related genes in the hypothalamus following TLR3 activation but did not significantly alter temperature. PPARα agonism did not alter TLR3-induced hyperthermia or hypothalamic inflammatory gene expression. These data indicate that OEA may be the primary FAAH substrate that modulates TLR3-induced neuroinflammation and hyperthermia, effects partially mediated by PPARα.


Subject(s)
Ethanolamines/pharmacology , Hyperthermia, Induced/methods , Inflammation Mediators/metabolism , PPAR alpha/metabolism , Toll-Like Receptor 3/administration & dosage , Amidohydrolases/pharmacology , Animals , Female , Gene Expression , PPAR alpha/agonists , PPAR alpha/antagonists & inhibitors , Poly I-C/toxicity , Rats , Rats, Sprague-Dawley
10.
Int J Hyperthermia ; 38(1): 202-212, 2021.
Article in English | MEDLINE | ID: covidwho-1120965

ABSTRACT

Increased transmissibility of the pandemic severe acute respiratory coronavirus 2 (SARS-CoV-2) has been noted to occur at lower ambient temperatures. This is seemingly related to a better replication of most respiratory viruses, including SARS-CoV-2, at lower-than-core body temperatures (i.e., 33 °C vs 37 °C). Also, intrinsic characteristics of SARS-CoV-2 make it a heat-susceptible pathogen. Thermotherapy has successfully been used to combat viral infections in plants which could otherwise result in great economic losses; 90% of viruses causing infections in plants are positive-sense single-stranded ribonucleic acid (+ssRNA) viruses, a characteristic shared by SARS-CoV-2. Thus, it is possible to envision the use of heat-based interventions (thermotherapy or mild-temperature hyperthermia) in patients with COVID-19 for which moderate cycles (every 8-12 h) of mild-temperature hyperthermia (1-2 h) have been proposed. However, there are potential safety and mechanistic concerns which could limit the use of thermotherapy only to patients with mild-to-moderate COVID-19 to prevent disease progression rather than to treat patients who have already progressed to severe-to-critical COVID-19. Here, we review the characteristics of SARS-CoV-2 which make it a heat-susceptible virus, potential host mechanisms which could be enhanced at higher temperatures to aid viral clearance, and how thermotherapy could be investigated as a modality of treatment in patients with COVID-19 while taking into consideration potential risks.


Subject(s)
COVID-19/therapy , Hyperthermia, Induced , Animals , Body Temperature , COVID-19/virology , Genes, Viral , Humans , Hyperthermia/immunology , Plants/virology , RNA Interference , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification
11.
Oral Oncol ; 116: 105240, 2021 05.
Article in English | MEDLINE | ID: covidwho-1091682

ABSTRACT

OBJECTIVES: Fever-range whole body hyperthermia (FRWBH) has been shown to improve tumor oxygenation in vivo. A prospective pilot study addressed the question if addition of FRWBH to re-irradiation is feasible in recurrent head and neck squamous cell carcinomas (HNSCC) with unfavorable prognostic features. MATERIALS AND METHODS: The study completed accrual with the recruitment of ten patients between April 2018 and March 2020. Re-irradiation was administered using volumetric arc hyperfractionated radiotherapy with bi-daily 1.2 Gray (Gy) single fractions and a total dose of 66 Gy to all macroscopic tumor lesions. Concomitant chemotherapy consisted mostly of cisplatin (7 patients). FRWBH was scheduled weekly during re-irradiation. The study was registered in the clinicaltrials.gov database (NCT03547388). RESULTS: Only five patients received all cycles of FRWBH. Poor patient compliance, active infections during treatment and study restrictions due to the Covid-19 pandemic were the main reasons for omitting FRWBH. No increase of acute toxicity was observed by FRWBH. Exploratory evaluation of outcome data suggests that FRWBH treatment according to protocol does not seem to have a detrimental effect on tumor control or survival and might even increase treatment efficacy. CONCLUSION: FRWBH is difficult to apply concomitant to re-irradiation in HNSCC. No excess toxicity was observed in patients receiving FRWBH and exploratory analyses suggest potential anti-tumor activity and decreased patient-reported depression scores after FRWBH.


Subject(s)
COVID-19/prevention & control , Hyperthermia, Induced , Re-Irradiation , Squamous Cell Carcinoma of Head and Neck/therapy , Aged , Antineoplastic Agents/therapeutic use , Cisplatin/therapeutic use , Combined Modality Therapy , Depression/etiology , Dose Fractionation, Radiation , Female , Humans , Male , Middle Aged , Patient Compliance , Pilot Projects , Prospective Studies , Quality of Life , SARS-CoV-2 , Squamous Cell Carcinoma of Head and Neck/psychology , Survival Rate
12.
Chem Biol Interact ; 334: 109339, 2021 Jan 25.
Article in English | MEDLINE | ID: covidwho-970426

ABSTRACT

Clinical trials of thermoheliox application (inhalation with a high-temperature mixture of oxygen and helium, 90 °C) in the treatment of the acute phase of coronavirus infection were conducted. Dynamics of disease development in infected patients (PCR test for the virus) and, dynamics of changes in blood concentration of C-reactive protein, immunoglobulin M, specific immunoglobulin G were studied. High efficiency of thermoheliox in releasing the organism from the virus and stimulating the immune response (thermovaccination effect) was shown. The kinetic model of the process is proposed and analyzed.


Subject(s)
COVID-19/immunology , COVID-19/therapy , Helium/administration & dosage , Hyperthermia, Induced/methods , Oxygen/administration & dosage , Administration, Inhalation , Adult , Aged , Antibodies, Viral/blood , C-Reactive Protein/biosynthesis , COVID-19/virology , Hot Temperature , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Kinetics , Middle Aged , Models, Immunological , SARS-CoV-2/immunology , Vaccination/methods
13.
Front Immunol ; 11: 556335, 2020.
Article in English | MEDLINE | ID: covidwho-993352

ABSTRACT

Introduction: Right now, we are facing a global pandemic caused by the coronavirus SARS-CoV-2 that causes the highly contagious human disease COVID-19. The number of COVID-19 cases is increasing at an alarming rate, more and more people suffer from it, and the death toll is on the rise since December 2019, when COVID-19 has presumably appeared. We need an urgent solution for the prevention, treatment, and recovery of the involved patients. Methods: Modulated electro-hyperthermia (mEHT) is known as an immuno-supportive therapy in oncology. Our proposal is to apply this method to prevent the progression of the disease after its identification, to provide treatment when necessary, and deliver rehabilitation to diminish the fibrotic-often fatal-consequences of the infection. Hypothesis: The effects of mEHT, which are proven for oncological applications, could be utilized for the inactivation of the virus or for treating the fibrotic consequences. The hypothesized mEHT effects, which could have a role in the antiviral treatment, it could be applied for viral-specific immune-activation and for anti-fibrotic treatments.


Subject(s)
COVID-19/rehabilitation , Electric Stimulation Therapy , Hyperthermia, Induced , Immunotherapy , Pulmonary Fibrosis/rehabilitation , SARS-CoV-2 , COVID-19/complications , COVID-19/epidemiology , Humans , Pulmonary Fibrosis/epidemiology , Pulmonary Fibrosis/etiology
14.
Med Hypotheses ; 146: 110363, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-971848

ABSTRACT

COVID-19 is a new contagious disease caused by a new coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is a disease that has reached every continent in the world; it has overloaded the medical system worldwide and it has been declared a pandemic by the World Health Organization. Currently there is no definite treatment for COVID-19. We realize that host immunity is a critical factor in the outcome of coronavirus 2 infection. Here, however, we review the pathophysiology of the disease with a focus on searching for what we can do to combat this new disease. From this, we find that coronavirus is sensitive to heat. We have thus focused on this area of vulnerability of the virus. The emphasis of this hypothesis is on the action of body heat-internal (fever) and external (heat treatment)-in activating the immune system and its antiviral activities, and specifically related to the coronavirus. We hypothesize from this review that heat treatments has the potential to prevent COVID-19 and to decrease the severity of mild and moderate cases of Coronavirus. We propose heat treatments for this uncontrolled worldwide coronavirus pandemic while studies are being done to test the effectiveness of heat treatments in the prevention and treatment of COVID-19.


Subject(s)
COVID-19/prevention & control , COVID-19/therapy , Hydrotherapy/methods , Hyperthermia, Induced/methods , Models, Biological , Pandemics , SARS-CoV-2 , COVID-19/virology , Combined Modality Therapy , Host Microbial Interactions/physiology , Humans , Pandemics/prevention & control , SARS-CoV-2/pathogenicity , SARS-CoV-2/physiology , Severity of Illness Index
15.
Diagn Interv Imaging ; 101(6): 347-353, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-108794

ABSTRACT

The COVID-19 pandemic has deeply impacted the activity of interventional oncology in hospitals and cancer centers. In this review based on official recommendations of different international societies, but also on local solutions found in different expert large-volume centers, we discuss the changes that need to be done for the organization, safety, and patient management in interventional oncology. A literature review of potential solutions in a context of scarce anesthesiologic resources, limited staff and limited access to hospital beds are proposed and discussed based on the literature data.


Subject(s)
Betacoronavirus , Cancer Care Facilities/organization & administration , Coronavirus Infections/epidemiology , Neoplasms/therapy , Pandemics , Pneumonia, Viral/epidemiology , Aerosols , Age Factors , Anesthesia, General , Anesthesiology/statistics & numerical data , Biopsy/adverse effects , Biopsy/methods , COVID-19 , COVID-19 Testing , Carcinoma, Hepatocellular/therapy , Carcinoma, Renal Cell/therapy , Chemoembolization, Therapeutic/methods , Clinical Laboratory Techniques/methods , Colonic Neoplasms/pathology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Databases, Factual , Health Personnel/statistics & numerical data , Health Resources/organization & administration , Health Resources/supply & distribution , Hospital Bed Capacity/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Hyperthermia, Induced/methods , Kidney Neoplasms/therapy , Liver Neoplasms/therapy , Lung Neoplasms/secondary , Lung Neoplasms/therapy , Neoplasms/complications , Palliative Care/methods , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , SARS-CoV-2 , Triage
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